Maturation of the vertebral ring apophysis is delayed in girls with adolescent idiopathic scoliosis compared to the normal population

Lorenzo Costa, Agnes van Lange, Peter R. Seevinck, Winnie Chu, Ludvig Vavruch, Moyo C. Kruyt, René M. Castelein, Tom P.C. Schlosser*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: The ring apophysis is a secondary ossification center on both sides of each vertebral body, to which the annulus of the intervertebral disc inserts. Recently, its pattern of ossification and fusion to the vertebral body was described for the normal growing spine. The aim of the present study was to investigate the ossification and fusion of the ring apophysis in patients with adolescent idiopathic scoliosis (AIS) and compare it to the normal growing population. Methods: Ring apophysis maturation along the entire thoracic and lumbar spine was analyzed on CT scans of 99 female, pre-operative AIS patients and compared to 134 CT scans of non-scoliotic girls, aged 12 to 20. Results: The ring apophysis maturation in AIS patients was delayed at all spinal levels in AIS patients compared to non-scoliotic controls. Ossification starts at T4–T11 at age 12, followed by T1–T5 and L3–S1 at age 15. The fusion process in AIS patients continues longer in the midthoracic region as compared to the other regions and as compared to non-scoliotic controls, with many incomplete fusions still at age 20. Conclusion: The ring apophysis maturation in AIS is delayed compared to that in the normal population and lasts longer in the mid/low thoracic spine. Delayed maturation of the spine’s most important stabilizer, while the body’s dimensions continue to increase, could be part of the patho-mechanism of AIS.

Original languageEnglish
Pages (from-to)1631-1637
Number of pages7
JournalSpine Deformity
Volume12
Issue number6
Early online date7 Jun 2024
DOIs
Publication statusPublished - Nov 2024

Keywords

  • Adolescent idiopathic scoliosis
  • Ring apophysis
  • Secondary ossification
  • Spinal maturation
  • Spine development

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